Journal of pediatric nephrology
Volume:2 Issue: 5, Autumn 2014

A 10-year-old male was transferred to hospital because of generalized edema and vomiting. He was healthy until 1 month ago when malaise, anorexia and edema developed. There were positive history of short stature and poor weight gain since childhood in this patient. Physical examination revealed a pale, lethargic, edematous and ill child with temperature of 37.5°C, pulse of 92/min, respiratory rate of 20/min and blood pressure of 160/100 mmHg. His body weight was 23 kg. auscultation of the chest revealed rales in lower parts of lungs, hyperkinetic heart, tachycardia with a III/VI systolic murmur in LSB. The patient had normal abdominal examination. Hypochromic anemia, hyperphosphatemia, increased level of creatinine, potassium and PTH and mild metabolic acidosis were seen in laboratory values. Chest x- ray and abdominal x-ray are shown in figure 1 and 2.

A 15-month-old female with an abdominal mass and no other significant findings on physical exam and lab data received abdominopelvic sonography and CT scan with contrast. On abdominal sonography, both kidneys were enlarged with multiple hypoechoic masses of variable sizes with distortion of the renal parenchyma (Figure 1). Abdominopelvic CT scan showed multiple variable sized non enhancing homogeneous masses in both kidneys which had led to renal enlargement. Normal renal parenchyma was merely descernable at the inferior pole of the left kidney and the rest of the parenchyma was noted as linear enhancements between the hypodense masses. Both kidneys excreted the contrast agent into the distorted pyelocalyceal system (Fiure 2).

A 15 day old male neonate was referred to emergence room with dribbling. He was term and his birth weight was 3 kg. Prenatal ultrasonography done at 35th week of gestation reported a suspicious cystic lesion on left kidney with no hydronephrosis. At admission time, physical examination was normal. Ultrasonography of urinary system showed mild fullness in right kidney. The second ultrasonography at 2nd month of age showed mild fullness in right kidney, (APD=4mm) and the size of RT and left kidney was 42 and 46 mm respectively. Kidneys echo were normal, both of distal ureters were dilated, (7mm diameter). Increase bladder wall thickness and fine trabeculation was reported too. Antibiotic for UTI prophylaxis was administered. At third ultrasonography there was a cystic lesion with 7mm diameter in corpous cavernosum. Voiding cystourethrogram (VCUG) was done

A 6 year –old girl was admitted because of pyelonephritis. She had a history of recurrent urinary tract infections (UTIs) and daytime wetting. Her urinary tract ultrasonography was shown normal kidneys, increased bladder wall thickening and volume of post voiding residual urine. In voiding cystoureterography there was no vesicoureteral reflux. Urodynamic study showed high pressure detrusor and low compliance. Due to some difficulty in passing urinary catheter during VCUG, the patient underwent cystoscopy.

A 3 year –old boy was admitted because of gross hematuria and abdominal pain. He had been treated with antibiotics over the past 4 days for a presumed lower urinary tract infection. The physical examination showed high blood pressure (BP: 130/95 mmHg) and abdominal mass. The physician performed the abdominal ultrasonography as a first line investigation for hematuria and abdominal pain (fig. A,B). Then he underwent abdominal CT scan for better diagnosis (fig. C, D).